Licence Appeal Tribunal File Number: 25-002694/AABS
In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.
Between:
Slaiwa Matti
Applicant
and
Wawanesa Mutual Insurance Company
Respondent
DECISION
ADJUDICATOR:
John Mazzilli
APPEARANCES:
For the Applicant:
Matthew Sutton, Counsel
For the Respondent:
Louise A Kanary, Counsel
Court Report:
Guido Riccioni
Arabic language Interpreter:
Jackleen Hanna
HEARD: by Videoconference:
December 9 and 10, 2025
OVERVIEW
1Slaiwa Matti (the” applicant”) was involved in an automobile accident on February 11, 2020, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by Wawanesa Mutual Insurance Company (the “respondent”) and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute
ISSUES
2The issues in dispute are:
Is the applicant entitled to the services proposed by Genesis Community Rehabilitation, as follows:
i. $10,714.36 for occupational therapy services, in a treatment plan submitted on January 6, 2023.
ii. $12,292.48 for occupational therapy services, in a treatment plan submitted on June 29, 2023.
iii. $8,552.86 for occupational therapy services, in a treatment plan submitted on October 19, 2023.
iv. $8,552.86 for occupational therapy services, in a treatment plan submitted on March 14, 2024.
v. $8,552.86 for occupational therapy services, in a treatment plan submitted on July 30, 2024; and
vi. $8,552.86 for occupational therapy services, in a treatment plan submitted on December 11, 2024?
vii. Is the applicant entitled $3,500.00 for chiropractic services, proposed by Back to Play Chiropractic in a treatment plan submitted on November 4, 2023?
viii. Is the applicant entitled to interest on any overdue payment of benefits?
AMENDED ISSUES
3At the hearing the parties advised that issue i. through vi listed above are in accordance with The Case Conference Report and Order dated June 25, 2025; however, the disputed occupational therapy treatment plans are related to a rehabilitation support worker and are not for occupational therapy. On consent of the parties, I amended issues i through vi, and accordingly I will consider whether the plans for a rehabilitation support worker are reasonable and necessary.
RESULT
4The applicant is not entitled to rehabilitation support worker services because it is not reasonable and necessary.
5The applicant is not entitled to chiropractic services because it is not reasonable and necessary.
6As no benefits are owing, interest is not payable.
ANALYSIS
Rehabilitation Support Worker Treatment Plan-Issue i
7I find on a balance of probabilities that the applicant is not entitled to $10,714.35 for rehabilitation support worker services because it is not reasonable and necessary.
8To receive payment for a treatment and assessment plan under sections 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
9The applicant submits that he has not returned to his pre-accident level of function. He submits that the disputed plans are reasonable and necessary from new injuries, namely sprains and strains, stemming from the accident and because of the exacerbation of pre-existing injuries to his hips and shoulder. He submits that the assistance from a rehabilitation support worker is reasonable and necessary to ensure re-integration into the community due to social isolation and functional limitations the accident has caused him.
10To support his claim the applicant relies on the occupational therapy report of Amanda Westbrook dated October 26, 2021, the testimony of Mohammad Alrazak, rehabilitation support worker, and the CNRs of Dr. Adamo, the applicant’s family physician.
11The respondent argues that the applicant had both of his hips replaced in and around 2015 and that there is no meaningful change in the applicant’s medical condition pre- and post-accident. It argues that the disputed treatment plans are not reasonable or necessary because the goals of the treatment plans have not been met. The respondent relies on the applicant’s Ontario Disability Support Program (“ODSP”) application, the occupational therapy reports of Linda Cottrell dated August 10, 2022, and October 11, 2023.
12The applicant testified that prior to the accident he was feeling ok although he had some pain in his leg and shoulder. He testified that he had both hips replaced in around 2013 and 2016 and that he used to go shopping, go to parks, work in his garden at home, helped his wife in the home, visit with friends, he visited his eldest son at his barber shop and would regularly drive his younger son to school. He testified that after the accident he cannot go out by himself and feels trapped as his friends and family are busy. He testified that his rehabilitation support worker Mohammad would take him to parks, the mall, to the lakeshore, festivals and would encourage him not to be depressed about his psychological problems and family issues between the applicant and his wife.
13I find that the applicant is not entitled to the disputed treatment plans for the following reasons:
14In this case I find that the applicant’s ODSP file does not support the applicant’s claim to the disputed treatment plans because the evidence shows that his pre-existing impairments are consistent with his post accident presentation and level of function and because the goals of the treatment plans have not produced any meaningful change in the applicant’s activity in or outside of the home.
15The applicant’s ODSP self report form dated January 30, 2019, approximately one year pre-accident supports my finding that the applicant’s pre-existing presentation does not substantially differ from his post accident presentation. In his ODSP self report, the applicant advises that he has severe pain and serious mobility issues preventing him from normal daily activities and that he is fully dependent on his wife at home for his personal care. Dr. Adamo, in the medical condition section of the application, lists the applicant as having difficulty walking, that he uses a cane, that he had bilateral hip replacement which causes pain and that he has a restricted range of motion affecting his mobility to do any indoor or outdoor activities.
16The applicant further advised ODSP that he is unable to walk more than 20 meters and unable to climb stairs. Dr. Adamo’s medical opinion in the ODSP application further informs that the applicant has bilateral shoulder tendonitis and tear which render him to be unable to do above shoulder activities which cause weakness in both arms presents as chronic pain which disturb the applicant’s sleep, the prognosis according to Dr. Adamo is continuous with future deterioration.
17In her report Ms. Westbook identified the applicant’s pre-accident routine as waking up and requiring some assistance with his upper extremity dressing and some of his bathing needs at times due to shoulder pain, he made his own breakfast, he drove his youngest son to school daily, he would complete errands in the community including grocery shopping and assisting at his eldest son’s barber shop by completing errands and picking up food for his son. He assisted his wife around the house with some vacuuming and sweeping, he completed snow shoveling and lawn care duties and completed other home maintenance as required, and that lunch and dinners were made by his wife.
18Ms. Westbrook identifies the goals of the OCF-18 as “Under the direction of the Occupational Therapist, the rehab support worker will facilitate and assist client with community reintegration and participate in functional tasks and meaningful activities. The rehab support worker will implement compensatory strategies to optimize the client's safety and level of independence, as well as assist the client with completing activities of daily living. The rehab support worker will monitor and document any emotional changes in behaviour from the client while engaging in program activities.”
19It is important to note that the respondent previously approved approximately 8 sessions for rehabilitation support worker service; however, it was not provided with progress notes from Ms. Westbrook or Mr. Alrazak and denied the disputed treatment plan based on the IE report of Linda Cottrell.
20The testimony of Mr. Alrazak and the applicant do not support the reasonableness and necessity of the plan because most of the identified goals were not achieved. For example, pre-accident, the applicant reported helping his wife with sweeping and vacuuming and completing home maintenance.
21Accepting Mr. Alrazak’s concession that he never went inside the applicant’s home, supports my finding that the goals of the plan were not met because the evidence shows that Mr. Alrazak did not assist nor help facilitate the applicant’s return to pre-accident activities, such as sweeping and vacuuming and home maintenance, mainly because of the applicant’s unwillingness to return to these pre-accident activities.
22In her report Ms. Cottrell was advised by the applicant that he was not interested in working towards goals such as light meal preparation, housekeeping and home maintenance tasks; consequently, I find the applicant’s report to Ms. Cottrell to be further supportive of a finding that the treatment plan is not reasonable and necessary.
23The applicant also reported, pre-accident, hanging out with friends at a park or a McDonald’s; however, in her report Ms. Cottrell reports that the applicant advised that he can no longer sit for a long enough period to do so. This is at odds with the applicant’s testimony and that of Mr. Alrazak, as they both testified that Mr. Alrazak would take the applicant to a Tim Horton’s or a short walk at a Lakeshore Park and would sit and talk on a park bench for a period of time. While Mr. Alrazak has attempted to engage the applicant in social activities outside of the home, it has not materialized into the applicant carrying on these activities on his own, therefore the goals of the plan are not being met.
24The medical evidence before me shows that the applicant does suffer from pre-existing chronic pain and at the hearing there were numerous suggestions that the applicant’s struggles with mobility and pain have affected his mental health, however, there have been no plans submitted by the applicant for chronic pain or a psychological assessment or treatment thereof.
25While re-integration into the community is a valid goal, the evidence of Mr. Alrazak is that the applicant did not carry out social integration on his own and that the applicant in part, used the sessions as a personal venting mechanism of his struggles, rather than re-integration into the applicant’s pre-accident level of function whether in or outside of the home.
26I find on a balance of probabilities that the applicant is not entitled to $10,714.35 for rehabilitation support worker services because it is not reasonable and necessary.
Rehabilitation Support Worker-Issues ii, iii, iv, v, and vi
27I find on a balance of probabilities that rehabilitation support worker services as listed in issues ii, iii, iv, v and vi are not reasonable and necessary.
28The goals of the treatment plans for issues ii, iii, iv, v, and vi are the same as the above listed plan, however issues ii, ii, iv, v and vi add the goals to include” the rehab support worker will monitor distances walked, walking for shopping purposes and facilitate more activities in the community”. The goals of the plans are as follows:
29“Under the direction of the Occupational Therapist, the rehab support worker will facilitate and assist client with community reintegration and participate in functional tasks and meaningful activities. The rehab support worker will implement compensatory strategies to optimize the client's safety and level of independence, as well as assist the client with completing activities of daily living. The rehab support worker will monitor distances walked, walking for shopping purposes and facilitate more activities in the community. The rehab support worker will monitor and document any emotional changes in behaviour from the client while engaging in program activities”.
30For the reasons above and the reasons that follow I find that the disputed plans are not reasonable and necessary. The applicant’s ODSP application does not support a finding that the plans are reasonable and necessary because the applicant’s reported walking distance limitations pre-accident do not substantially differ from his reported post-accident walking limitations. In addition, the rehabilitation support worker notes do not point to progress in the applicant’s walking distances.
31The progress reports show staggered walking distances, of 100 meters, 80 meters, and 150 meters walked; however, at the time of the ODSP application the applicant alleges he can only walk 20 meters. This to me does not demonstrate that the applicant’s level of walking function has been restricted by the accident as he is able to walk further distances post-accident than his reported pre-accident level of function, which I find is further supportive of a finding that the plans are not reasonable and necessary.
32I find on a balance of probabilities that rehabilitation support worker services as listed in issues ii, iii, iv, v and vi are not reasonable and necessary.
Chiropractic treatment plan in the amount of $3,500.00
33I find on a balance of probabilities that the applicant is not entitled to $3,500.00 for chiropractic services because it is not reasonable and necessary.
34The applicant submits that the disputed plan is reasonable and necessary due to increased pain of his pre-existing condition and because of his accident-related injuries, namely a sprain and strain to his neck and lower back that is extending to his leg and causing the applicant to have a diminished function. The applicant testified that chiropractic intervention provided exercises and massage for shoulders and back and leg that would give him relief. The applicant relies on an OCF-18 dated November 2, 2023, completed by Dr. Yousif, chiropractor and his testimony.
35The respondent argues that the applicant’s pre and post accident presentation do not substantially differ from the applicant’s ODSP application. It argues that the applicant, as a result of the accident, sustained sprains and sprains to his neck, and lower back that ought to have resolved given the passage of time and the extensive chiropractic treatment that the applicant received. The respondent relies on the report of Dr. Paitich, orthopedic surgeon dated December 7, 2023.
36I find that the chiropractic treatment plan in dispute is not reasonable and necessary for the following reasons.
37The applicant’s treating chiropractor, Dr.Yousif identified the goals of the treatment plan to be pain reduction, increase in strength and increase in range of motion and the functional goal is to return to activities of normal living.
38Dr. Yousif testified that the applicant’s pain was back and forth, sometimes the applicant had issues and sometimes he didn’t, sometimes it was neck pain and other times it was tightness and tenderness in his lower back. While pain relief can be a legitimate goal, I am not pointed to evidence on how the functional goal of the plan of a return to activities of normal living are being met.
39For this reason, I placed more weight to the report of Dr. Paitich and accept his medical opinion that all of the applicant’s accident-related pathology has long since healed as of his assessment approximately 3 years post accident and that the treatment plan is “neither reasonable, nor required or necessary in its entirety”.
40I find on a balance of probabilities that the applicant is not entitled to $3,500.00 for chiropractic services because it is not reasonable and necessary.
Interest
41Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are owing, interest is not owing.
ORDER
42It is ordered that:
i. All the disputed treatment plans are not reasonable and necessary.
ii. As no benefits are owing, interest is not owing.
iii. The application is dismissed.
Released: January 21, 2026
__________________________
John Mazzilli
Adjudicator